Focal early stage cancer in ampullary adenoma: surgery or endoscopic papillectomy?

Gastrointestinal Endoscopy
Soon Man YoonSung Koo Lee

Abstract

Recently, the evidence has been accumulating that endoscopic resection may be curative in treating ampullary adenoma that contains high-grade intraepithelial neoplasia/in situ tumor (HGIN/Tis). However, there are only anecdotal reports of endoscopic management of "focal" T1 ampullary cancer (T1 cancer), and radical surgery is still considered the only accepted treatment modality. To assess the possibility of endoscopic papillectomy as an alternative to radical surgery for the treatment of ampullary adenoma with HGIN/Tis or focal T1 cancer. Retrospective evaluation of case series of our hospital from 1996 to 2006. Tertiary-care university teaching hospital. Twenty-three patients who had HGIN/Tis or focal T1 cancer in ampullary adenoma resected by endoscopic papillectomy and 60 patients who initially underwent radical surgery for HGIN/Tis or T1 cancer of the ampulla of Vater. "Focal" was defined as a lesion involving only mucosa, with a size less than a fourth the diameter of main adenoma. Review of medical records and analysis of surgically or endoscopically resected specimens of ampullary tumors. Locoregional extension and follow-up data. Patients with HGIN/Tis of the ampulla of Vater had no lymphovascular invasion or lymph-nod...Continue Reading

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